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Having asked out loud whether anyone could explain a couple of odd FtP decisions, I got this from Nathan Emmerich, offering sociological pop at an answer…

Iain wondered if anyone could explain the morality that underlies a couple of recent Fitness to Practise decisions made by the GMC. Well, more accurately he wondered if anyone could explain the “public perception” or “public confidence” aspect of the GMC’s Fitness to Practice guidelines. Never one to shirk a challenge, I thought I would give it a go…

The first thing to note is that one has to change, or perhaps expand, the terms of the debate. As a discipline applied philosophical bioethics tends to focus on “ethics”, “ethical reasoning” and codified rules over what I (and some others) would call “morality”. For our present purposes the starkest way to express the idea is by appeal to the historical morality of the UK medical profession, which used to be based on the idea of the British gentleman of a certain class and standing (and, obviously, race and gender).

This morality was uncodified – it had no explicit ethics. Indeed, more than this, it was held to be uncodifiable both in principle and as a matter of morality. It was thought it would be wrong to codify gentlemanly (medical) morality as to do so would open the way to, first, individuals who merely followed rules rather than being the correct sort of persons or having the right character. Second, it would lead to people who did not have the right character or standing attempting to second-guess the decisions of medical professionals or gentlemen. Such a thing was, of course, intolerable.

There is no denying that there was a lot wrong with this ‘moral culture’, and a range of factors has been influential in the modification of medical morality from this historical position to the one we have today. However, “medical morality” has vanished completely, indeed, it is impossible for it to do so: the medical profession (indeed any profession or cultural group) has some underlying moral ethos. Some cultures, like modern medicine, may also have explicitly stated ethical codes and guidelines that may be more or less in line with the underlying moral culture. Nevertheless the moral culture itself is not obviated by these codes. Indeed it underpins the existence and application of any such formally stated ethics.

The problem here is that no rule contains the principles of for its own application. more…

Did you hear the programme about syphilis on Radio 3 on Sunday? If not, you can catch up on it here – and I’d thoroughly recommend doing so: it was superb.

One bit in particular caught my attention; it had to do with the use of penicillin to treat the illness during World War II. (It’s from about 38:40 on the iplayer version.) Astonishingly, in 1942, more men were out of action in North Africa because of syphilis than because of battlefield wounds. Obviously, penicillin would be of immense help to both groups; but the problem was that there was not enough of the drug to meet both demands. Giving it to the wounded obviously had some moral gravity… but so did giving it to the syphilitic: after all, they’d be cured and battle-ready very quickly, whereas the wounded might never be battle-ready again.

Thanks to Brian Earp for bringing this release from the US’ National Institute of Mental Health to my attention; it concerns the Institute’s decision to move away from DSM as its diagnostic tool. DSM has been enormously successful – in terms of having established itself at the centre of psychiatry – but it has been enormously controversial, as well; the NIMH moving away from it is very big news indeed. Whether the new model that they’re going to be working on will be any better, of course, remains to be seen.

The important bit seems to be this:

NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system.

Can the language of compassion capture the moral problems confronted by the NHS, or might it obfuscate and distract us from more subtle and demanding issues?

Through a series of plenary addresses, workshops, panels and shared opportunities for discussion, “Compassion Fatigue” will provide an opportunity to explore the language of compassion, and the impact that it has on the practice of health care provision.

Imagine you are a doctor, nurse or teacher and someone in your care asks for a razor. The person you look after wants to slice into their own skin and draw blood. They are compelled to hurt themselves. They have an overwhelming urge to feel a momentary visceral sense of pain. Would you provide them with a blade? Is it ever right to enable people in your care to harm themselves?

At first glance such questions may appear shocking and seem likely to elicit a strong gut reaction. Surely it can’t be right for people in a position of authority, with a duty of care to be seen to apparently condone or provide a means for vulnerable people to engage in such self-destructive behaviour?

Yet recent media reports (such as this and this) suggest that such a choice has already been made. Teachers at Unsted Park gave a “special needs” pupil sterile Bic safety blades so they could injure themselves in the privacy of the school bathroom. According to reports, staff checked in on the pupil every two minutes. After the pupil had finished cutting teachers cleaned and dressed their wounds.

The news story attracted a predictable sense of outrage. Readers commenting on newspaper message boards found the school’s decision at best incomprehensible and often disgusting and immoral. According to the top-rated comments on the Daily Mail website:

That’s Nuts! What’s wrong with these people??!!!

And

Absolutely shocking, I am by far an expert in the field but that sounds ridiculous to me

Unfortunately such feelings of revulsion and disgust are not limited to the comment boards of the Mail. One of the authors of this blog was told by another academic that their doctoral abstract on the subject of self-harm made them feel physically sick.

The news reports on the case at Unsted School are vague. The nature and severity of the pupil’s injuries are unclear and the age of the pupil is put between seven and nineteen. Without more detailed information it would be disingenuous to comment at length on this specific case. The Unsted Park School policy of allowing the pupil to self-harm has since been abandoned after some of the teachers complained to the local authority.

It is not the first time that the issue of institutional enablement or allowance of self-harm has been subject to scrutiny. more…

A bit more on the cochlear implant thing that I’ve been mentioning off and on for the past couple of months. William Mager posted a link to something a little while ago on why some members of the deaf community are against CIs. This attitude had always puzzled me. Anyway, this, by Christina Hartmann, is the thing to which he linked.

Not wanting one yourself, I can understand easily enough. Not wanting one for your children based on uncertainty about their benefit, I can understand. But being against them in principle? Couldn’t get my head around that. It always seemed a bit wilfully isolationist – a bit identity-politics. Hartmann’s contribution, I think, makes things a bit clearer.

Without ASL, there is no Deaf community. We band together not because of our “hearing loss” but because of a common language. Like English, Bengali, French, American Sign Language (ASL) informs the cultural underpinnings of the Deaf community. Deaf history shows the importance of ASL to Deaf people. It’s not something we’ll give up easily and gladly.

In the 1800s and early 1900s, many educators tried to eradicate ASL in favor of oralism. They wanted to assimilate deaf people into the “mainstream” community. Many deaf people suffered because of this. They received marginal education because they couldn’t understand the spoken language. One of the older deaf men that I knew in my childhood couldn’t get a job better than a janitor because he received no valuable education from his oral school. They just tried to teach him how to talk, to no avail.

Amidst all of this, a vibrant community emerged. People would converge at Deaf schools and churches just for a chance to use their own language with someone else. A feeling of kinship grew in face of oppression. (Yes, trying to abolish a language and forcibly integrate people is oppression.) Many Deaf people throughout history fought very hard for the right to sign and live on their own terms. One example is the Gallaudet protests of the 1980s. The thought that this hard-earned culture will disappear because parents don’t want to learn ASL sparks abject fear and anger in many Deaf people.

And why not? Wouldn’t you be angry if someone told you that your culture is outdated and irrelevant now?

This last sentence or two seems to me to be important. CIs reduce the need for ASL (or BSL); SL sustains a culture; therefore CIs erode that culture. more…

People who listen to Today may have heard an article in the prime 8:10 slot on the 9th about the correlation between a drop in the use of leaded petrol, and a drop in violent crime rates. (Mother Jones actually beat the BBC, having published a piece on the same research last week: I meant to post something then, but was buried by other stuff.)

The nub of the story is this: that violent crime has been falling in the past few years, and though this pattern seems to lag about 20 years behind a fall in the use of lead in petrol, the fit is pretty good: a decline in leaded petrol predicts a decline in violent crime by about two decades – which is just about the time that we might expect would elapse between the formation of the brain and the highest likelihood of violent behaviour in humans. Neat. The Mother Jones piece provides lots of links to the relevant research – links to this (from 1999), and this (from 2007), and this (from 2012).

If the lead hypothesis is sound, it seems to be ethically interesting in a couple of ways. For one thing, it opens the way to at least some antisocial behaviour to be seen as being symptomatic of a deeper public health problem. That’s interesting enough as it is, but – admittedly – it might be little more than interesting, on the grounds that leaded petrol is pretty much a thing of the past anyway (Wikipedia says that, as of 2011, leaded petrol was widely available only in 7 countries).

But the other way in which it’s interesting has to do with arguments about so-called “moral enhancement”. more…

British Postgraduate Philosophy Association Masterclass 2013April 12th-13th, University College London

This year’s BPPA masterclass will be on concepts of mental health, and applications are invited from graduate researchers within the field of philosophy and mental health.

A masterclass involves a mixture of seminars, group workshops, presentations by students and experts and critical discussion. The small number of participants (8-10) means that all will have a chance to speak and discuss their research as well as getting to know others working in similar areas. It is an excellent way of deepening and broadening understanding of a given area and further developing one’s own research.

This year’s masterclass will be led by experts committed to furthering interdisciplinary research into mental health issues, combining philosophical training with clinical experience. Professor Bill Fulford is Emeritus Professor of Philosophy and Mental Health at the University of Warwick and is a Member of the Philosophy Faculty at the University of Oxford. His previous posts include Honorary Consultant Psychiatrist at the University of Oxford and Special Adviser for Values-Based Practice in the Department of Health. Dr Hanna Pickard is a fellow of All Souls College at the University of Oxford and a Wellcome Trust Biomedical Clinical Ethics Research Fellow in the Department of Philosophy at the University of Oxford. She also holds a clinical post as a therapist at the Complex Needs Service with the Oxford Health NHS Foundation Trust. The experts will be leading group-workshops and seminars and will present on their own research over the course of the masterclass.

The broad focus of the masterclass will be on exploring the varying conceptions of mental health and illness and the assumptions accompanying and lying behind these conceptions. The aim is to explore the assumptions and often false dichotomies which shape perceptions of mental health, from the perceptions of those in the field of psychiatry to those found amongst other medical professionals and the non-medical public. Topics we expect to be discussed include, but are not restricted to

free will, responsibility and related notions and their applications and misapplications within understanding of mental health problems, in particular in relation to addiction;

the effect of neurological research on conceptions of mental health;

the distinction between cognitive disorders and personality disorders;

the extent to which mental illness can and ought to be understood within the framework of physical illness.

The precise content of the masterclass will be in part determined by the research interests of the participants and there will be opportunities for 6 participants to present their own research.

To apply, send an academic CV (including any relevant clinical or practical experience) with a cover letter stating your area of research, the relevance of your research to the masterclass and what you could contribute to the masterclass (500 words max). Please also state whether you would like to present on your research (presentations will be brief – about 20 minutes each). Please also attach a reference from your supervisor (if applicable), confirming your interest and that you would make a valuable contribution to the masterclass.

The masterclass will be held at University College London. Breakfast and lunch will be provided on both days and accommodation for those coming from outside of London. There may also be some small travel bursaries available.

A few weeks ago, I linked to a post on William Mager’s blog in which he said (a) that he was about to have a cochlear implant fitted, and (b) that he’d write about the experience as it progressed.

I don’t know how many readers of this blog followed the link or subscribed; for those who didn’t, I thought I’d just point you in the direction of the latest update. In short: the implant was fitted; it was turned on; it was… unexpected. Not completely pleasant from the word go, and a little odd. But also… well:

I spent an hour yesterday walking round the house tapping different surfaces with a wooden drumstick. Before, with a hearing aid, I’d have heard these taps simply as a ‘tap’ sound. But I had a eureka moment when I realised that tapping a wooden stick on a wooden surface sounded different in pitch and tone to tapping on a glass surface, or a metal surface. Of course, I knew that was the case – but this was the first time ever, EVER… that I’d actually heard that and been able to distinguish so clearly between the different sounds.

That has to be a little bit magical, doesn’t it?

On the other hand, what he can hear is limited. And so

[n]ow I’m sitting in a world of silence, punctuated by random, violent bursts of sounds that I’ve never heard or experienced quite in the same way before.

What I’m experiencing now isn’t hearing as I imagined it, or as I’ve known it for the last 30 years. It’s completely different, and it’s making me feel really tired and disconnected from everything. I’m finding it really hard to concentrate, to hold on to a specific thought for a long time. […]

Most disconcerting of all is the dawning realisation that what I thought I was hearing for the last 30 years of my life wasn’t actually hearing. It was just compressed, distorted garbage noise through a hearing aid. What I’m feeling in my head now is much, much closer to actual sound, but it isn’t sound.

I’m fairly confident in my hunch that being able to hear is on the whole preferable to not being able to hear; though there might be times when not hearing is preferable, being able to do so at least gives you the choice – which raises the intriguing possibility that someone with a device that he could used to switch his own hearing on or off might be, in that sense at least, very well off indeed: better off than someone with no ability to hear and someone with no ability not to. (In just the same way, having a car is good all else being equal, even if there’re times when walking is preferable, because you have the option of using it.)

But still: it’s worth keeping in mind that the process of restoring – or instilling – hearing isn’t a straightforward leap from position A to more desirable position B. There’s an ambiguity about it. Even granted confidence that B is more desirable, we can’t take it for granted.

I am going to, rather controversially, agree with one aspect of the statements of pro-life activists commenting on this case. That is not something I thought I’d ever say. Like, ever ever.

A statement issued by Youth Defence (one of Ireland’s most radical pro-life organisations) made the valid point that “Irish doctors are always obliged to intervene to save the life of a mother, even if that risks the life of her baby”. Because of some misconceptions about the reasons for Savita’s maltreatment, it is assumed that Ireland needs to reform its abortion law so that this never happens again. While I would strongly support abortion law reform in Ireland, it is not necessary to ensure this never happens again. Mere legal regulation of the status quo on abortion would prevent this. As the (limited) law stands, this should never have happened at all. While some believe that legislation to regulate access to already lawful abortions constitutes law reform, any such legislation would not alter the current legal position – it would merely give meaningful access to abortions.

I don’t agree with anything else that has been included in pro-life posts/articles (stop throwing things at your computer screens), but more on that later. First, I want to elaborate on this to clear up some of the misconceptions about Irish law that have been expressed in condemnations of the case around the web.

If you have clicked through to this post, it is very likely that you’ve already read about the facts of Savita’s case, first reported in the Irish Times on 14 November, and at least some of the estensive commentary pieces available on the issues arising from this case (like this, and this, and this). (These links here are to pieces by Irish people with more informed knowledge of the legal situation.)